tbuckley/cabot-search huggingface dataset:
Efficacy and safety of tunlametinib in patients with advanced NRAS-mutant melanoma: A multicenter, open-label, single-arm, phase 2 study.
Authors: Lu Si, Zhengyun Zou, Weizhen Zhang, Meiyu Fang, Xiaoshi Zhang, Zhiguo Luo, Jing Chen, Gang Huang, Peng Zhang, Ying Cheng, Jiwei Liu, Jiyan Liu, Junping Zhang, Di Wu, Yu Chen, Xiaobiao Ma, Xiaoting Wei, Peng Sun, Zhongwei Jia, Jun Guo
Journal: Journal of Clinical Oncology (2023)

9510 Background: NRAS-mutant melanoma is an aggressive subtype with worse prognosis. However, no targeted therapy has been approved to date worldwide. Tunlametinib (HL-085), a novel, potent, selective, oral small-molecule MEK1/2 inhibitor, has showed a favorable pharmacokinetics profile, acceptable tolerability and encouraging antitumor activity in the phase 1 study (BMC Med. 2023 Jan 4;21(1):2). Methods: This is an ongoing, multicenter, open-label, single-arm, phase 2 pivotal registration study. Patients (pts) with NRAS-mutant unresectable stage III or IV melanoma were enrolled and received tunlametinib 12 mg orally twice daily. A historical control of objective response rate (ORR) of 10% was predefined for sample size estimation (100 pts, assuming loss to follow-up rate of 5%) and efficacy evaluation. The primary endpoint was the confirmed ORR per RECIST v1.1 assessed by independent radiology review committee. Results: A total of 100 pts were enrolled. All pts were included in the safety analysis set and 95 pts were included in the full analysis set (FAS) for efficacy analysis. At cut-off date (August 17, 2022), median follow-up was 7.9 months (95% CI: 6.6, 9.8). In the FAS, the median age was 58.0 years (range: 24 to 84). Sixty-four pts (67.4%) had received prior immunotherapy (PD-1/PD-L1 inhibitor). Fifty-six pts (58.9%) were acral melanoma, 16 (16.8%) mucosal melanoma and 12 (12.6%) skin melanoma. Fourteen pts (14.7%) were stage III and 81 (85.3%) stage IV. The most frequent NRAS mutation types were Q61R (40.0%), Q61K (29.5%) and G12D (9.5%). Confirmed ORR was 34.7% (95%CI: 25.3%, 45.2%). Median progression-free survival was 4.2 months (95%CI: 3.5, 5.6), overall survival was immature, and 1-year survival rates was 57.2% (95% CI, 44.7%, 67.8%). Subgroup analysis showed that, in pts who had previously received immunotherapy, the confirmed ORR was 39.1% (95% CI: 27.1%, 52.1%). The most frequent treatment related adverse events (TRAEs) were increased blood creatine phosphokinase (CK), diarrhea, peripheral oedema, facial oedema and increased aspartate aminotransferase. Grade ≥3 TRAEs occurred in 68 pts (68.0%), of which 38.0% (38/100) were increased blood CK. Most of pts with CK elevation are asymptomatic and can be managed by dose interruption or reduction without permanent treatment discontinuation. No treatment-related death was reported. Conclusions: Tunlametinib was well tolerated and demonstrated encouraging treatment response rate in pts with advanced NRAS-mutant melanoma. These results indicate that tunlametinib could be a promising treatment option for NRAS-mutant melanoma, even for those immunotherapy failed pts. Clinical trial information: NCT05217303 .
Tolerability of capecitabine in difference racial/ethnic groups.
Authors: Joshua Dower, Yana Salei, Brett Dumas, Ilana Schlam
Journal: Journal of Clinical Oncology (2023)

e18833 Background: Capecitabine (cap) is an oral chemotherapy agent used for treatment of solid malignancies. The recommended dose of cap generally ranges from 1000mg/m 2 to 1250mg/m 2 twice daily, but many patients require a dose reduction during treatment due to AE. It is unclear whether patients of different race have better tolerability of cap than others. In Asian populations for example, potential differences in tolerance have been attributed to low dietary folate intake. Race is a social construct; however it has been used to identify groups of patients within a population. We aimed to understand the tolerability of cap among patients of different racial/ethnic groups. Methods: In this retrospective chart review, we studied patients treated with cap at Tufts Medicine (three centers in MA, USA) between 2017-2021. Patients treated with cap alone, concurrent with other chemo, or concurrent with radiation for solid tumors were included. Patients were excluded if race/ethnicity data was not available. We collected demographic information, cap dose, AE, and dose reductions during the treatment period. Dose intensity (DI) was calculated (Total administered cap dose during treatment period (mg)/Recommended cap dose (mg/m 2 ) * BSA (m 2 )). ANOVA was used to determine difference between groups. Results: 202 patients were included: 134 (66.3%) White, 35 (17.3%) Asian, 22 (10.9%) African American/Black, and 11 (5.4%) other race. 10 (5%) identified as Hispanic ethnicity. Most common cancer types treated were 46 (22.8%) breast, 44 (21.8%) colon, and 39 (19.3%) rectal. Average DI by race/ethnicity is outlined in Table 1. There was no statistically significant difference in DI among patients of different racial groups (p = 0.232). AEs leading to dose reduction or cap discontinuation occurred in 93 (46%) of patients, the most common outlined in Table 1. Conclusions: We found no significant difference in cap DI or toxicity among patients of different racial groups. The study is limited by the small sample size and that it is retrospective. The patients presented are racially diverse but live in one geographic area, which could impact environmental factors such as dietary folate intake. Our findings suggest that there is no difference in tolerated DI among all patients. Clinicians should not empirically reduce the dose of cap based on race and should assess tolerance on an individual basis. [Table: see text]
Deep learning algorithm for automatic prediction of visceral pleural invasion of lung cancer based on surgical video.
Authors: Hao Xu, Wei Mu, Ruiyang Zou, Caifang Cao, Zewen Sun, Sida Cheng, Tian Guan, Hao Li, Xiuyuan Chen, Guanchao Jiang, Fan Yang, Jun Wang, Jie Tian, Jian Zhou
Journal: Journal of Clinical Oncology (2023)

e20578 Background: Visceral pleural invasion (VPI) is an important prognostic indicator in lung cancer that is difficult to predict. We aimed to develop a deep learning algorithm that predicts VPI using videos of lesions. Methods: We included 346 patients who underwent thoracoscopic surgery at our department from 2015 to 2021, corresponding to 3800 images. The patient data and image data were divided into training set, validation set and testing set. The algorithm was developed based on the ResNet architecture used for image feature extraction and classification. All images were labeled for lesions and processed to fit the algorithm. We recruited two thoracic attendings and one radiologist to identify VPI using intraoperative video and preoperative CT, respectively. The performance of the algorithm was evaluated by comparison with the performance of the attendings and the radiologist. Results: At the patient level, the algorithm had satisfactory AUC values in the training set (0.85), validation set (0.83) and testing set (0.81). The DeLong test showed statistic difference between the algorithm and two attendings and a radiologist in the training set (p &lt; 0.001, p &lt; 0.001, p &lt; 0.001), validation set ( p= 0.006, p= 0.002, p= 0.026) and testing set ( p= 0.008, p= 0.012, p= 0.007). At the image level, the algorithm also outperformed two attendings and a radiologist with significantly great AUC values in the training set (0.83 vs. 0.52 vs. 0.53 vs. 0.65; p&lt; 0.001, p&lt; 0.001, p&lt; 0.001), validation set (0.78 vs. 0.50 vs. 0.54. vs. 0.68; p&lt; 0.001, p&lt; 0.001, p= 0.048) and testing set (0.79 vs. 0.53 vs. 0.60 vs. 0.58; p&lt; 0.001, p&lt; 0.001, p&lt; 0.001). Conclusions: The video-based deep learning algorithm could satisfactorily predict VPI and achieved expert-level performance better than thoracic attending surgeons and the radiologist we recruited.
Understanding barriers to LGBTQ+ cancer clinical trial participation: A qualitative inquiry.
Authors: Elif Andac-Jones, Maria Belen Gonzalo, G. Thomas Wilson, Rachel Saks, Nicholas James Power
Journal: Journal of Clinical Oncology (2023)

e18675 Background: It is well documented that LGBTQ+ cancer patients face severe challenges in accessing care and resources. Barriers are persistent despite recent advancements. Cancer clinical trial (CCT) participation rates for LGBTQ+ communities reflect this disparity. Understanding the reasons behind low participation rates and evaluating how LGBTQ+ specific experiences differ from the general population can help develop resources and programs that address the disparities in CCT participation, advancing LGBTQ+ health equity. Methods: In October 2022, CSC facilitated two virtual focus groups with 12 adults diagnosed with cancer and self-identifying as LGBTQ+. Participants were recruited from CSC’s Cancer Experience Registry (CER), representing wide gender and sexual orientation spectrums, a variety of cancer diagnosis and treatment trajectories, were 26-83 years of age, and a majority were college educated. A pre-screener survey collected sociodemographics to diversify the participant profile. Focus group data included participants' background, their experiences living with cancer as members of LGBTQ+ communities, and knowledge, attitudes, and experiences with CCTs. Transcripts were analyzed using deductive codes of sociodemographic information and inductive codes based on emergent themes. Results: LGBTQ+ patients reported: 1—Perceived institutional discrimination by healthcare providers in addressing their needs resulting in trust issues among patients; and 2—Relational and informational barriers block LGBTQ+ participation in CCTs. 19/21 screening survey respondents and 11/12 focus group participants had heard of CCTs, though none had participated. Each expressed a strong desire to help others and contribute to cancer research. However, patients doubted the medical ethics and personal benefits of CCTs, and most believed there are selective biases in recruitment. Conclusions: LGBTQ+ patients feel discriminated against when advocating for their health, identity, and rights, and struggle to trust their medical providers. Experiences of mistrust and discrimination inform LGBTQ+ patients’ perspective on and participation in CCTs. Findings suggest a need for 1—well-developed informational materials addressing the needs of LGBTQ+ communities; 2—better education and engagement of CCT teams on how to address those needs.
Examining experiences of African American patients with breast cancer in a multidisciplinary survivorship clinic.
Authors: Madeleine Uelk, Nazzara Chervinko, Cathy Grace Louthen, Arpan Patel, Patricia A. Robinson, Kathleen Fujiu
Journal: Journal of Clinical Oncology (2023)

e18621 Background: Breast cancer (BC) is the most commonly diagnosed cancer in women. More effective therapies have led to improved survival rates, yet, the survival benefit is not shared across all patient (pt) populations, with worse breast cancer outcomes among African American (AA) pts. The American College of Surgeons has mandated that accredited sites have a cancer survivorship program. At the Cardinal Bernardin Cancer Center (CBCC), there remain disparities in access and utilization of the survivorship clinic, especially by AA BC survivors. Of the 385 new BC analytic cases CBCC treated between March 1, 2020, and March 1, 2021, 72 of these were AA pts. Unfortunately, less than 10% of AA BC pts who received curative intent therapy attended the CBCC Survivorship Clinic. As part of the "Bringing Quality Care Training to Komen’s African American Health Equity Initiative" in collaboration with ASCO, CBCC remodeled its survivorship program into a multidisciplinary clinic staffed by medical oncology, oncologic psychology, genetic counselor, nutritionist and social worker in order to provide comprehensive care to pts following diagnosis and treatment. Methods: The CBCC team performed the following: construction of a process map outlining the current pathway for referring pts to the survivorship clinic; creation of a fishbone cause and effect diagram highlighting factors contributing to poor utilization of the clinic; implementation of faculty surveys to assess reasons for lack of referral to survivorship clinic; development of pt experience surveys; and identification of countermeasures. Tumor registry identified BC pts by stage, race, and ethnicity. Results: Review of the CBCC BC registry showed a low attrition rate among 72 AA pts, with only 1.4% (n = 1) of AA pts diagnosed at CBCC treated elsewhere. AA pts made up a disproportionate number of stage IV diagnoses comprising 40% (n = 8). Surveys demonstrated the following reasons for poor utilization of the survivorship clinic by faculty in order of descending importance: providers felt they were providing survivorship care to their pts; pts declined referral due to appointment fatigue; lack of understanding to make referral; no outcomes data to support survivorship clinics; pt misunderstanding the purpose; fear of losing the pt; pt financial burden. Pt surveys (n = 20) showed high pt satisfaction, with an average rating of 4.8 out of 5 for overall care. Conclusions: Lack of utilization of the cancer survivorship clinic among AA BC pts leads to inefficient application of resources, decreased survivorship care, reduced pt experience, and diminished opportunity for survivorship education and increased health literacy. Paths for the future include increased faculty and pt education, faculty engagement, designated scheduler for survivorship clinic, and increased promotional and marketing work.
Barriers to HIV-associated lymphoma diagnosis in Soweto, South Africa: A nurse's perspective.
Authors: Gugulethu Tshabalala, Nomathemba Tshabalala, Neil Martinson, Richard F. Ambinder, Janan Dietrich, Samantha Vogt
Journal: Journal of Clinical Oncology (2023)

e18727 Background: Delayed diagnosis of aggressive lymphoma in people living with HIV (PLWH) in South Africa is an emerging public health crisis due in part to PLWH living longer on antiretroviral therapy. The main driver of this delay has been shown to occur during the healthcare-practitioner interval that represents the time from presentation to the healthcare center until a diagnosis is confirmed. We set out to explore the barriers contributing to the prolonged healthcare-practitioner interval during the diagnosis of aggressive B-cell lymphoma in PLWH. We provide a nurse perspective, often the first contact a patient will have within the public healthcare sector in Soweto, South Africa. Methods: We conducted a total of nine qualitative in-depth interviews (IDIs) between May-August 2022 with nurses at four public healthcare clinics in Soweto, South Africa. Eligible participants were purposively sampled provided that they had at least 5 years’ experience working with PLWH. All IDI’s were conducted by an experienced, multi-lingual qualitative researcher in a private room at the respective clinic. A semi-structured interview guide was developed to explore the following topics: provider experience in the healthcare system, experience with taking care of PLWH and experience in distinguishing lymphoma from tuberculosis (TB). The interviews lasted on average 67 minutes and were conducted in the participants preferred local language and/or English. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis mapped onto a socio-ecological model exploring barriers at the institutional level. Results: Majority of participants were female (7/9; 78%) with a median age of 39 years. Two nurses held enrolled nurse qualifications (entry level) and 7 nurses held professional qualifications with a median of 10 years’ experience in healthcare. Participants report fundamental barriers that occur at the health system level including limited knowledge about lymphoma by providers; structural limitations at the clinic including staffing shortages and limited resources; poor referral/triage process for lymphoma; and lack of continuity in patient care. In contrast, a clear referral process for TB diagnosis and treatment was noted by the nurses. Nurses perceived that patient level barriers that result in advanced stage cancer presentations include use of alternative and traditional medicine. Conclusions: A clear distinction between referral and triage of suspected TB vs lymphoma diagnoses emerged. Nurses perceive that utilization of traditional medicine by patients results in advanced stage cancer diagnoses. Interviews with lymphoma patients are ongoing and interviews with providers at the TB clinics and with traditional healers in the region are planned to better understand the role that these barriers play in delayed lymphoma diagnosis in South Africa.
Association of immune-related adverse events and improved treatment outcomes across race/ethnicity in a diverse patient population.
Authors: Chinmay Jani, Amr Radwan, Omar Al Omari, Mohini Patel, Laura Burns, Zoe Mackay, Liuping Li, Kiana Mahdaviani, Janice Weinberg, Peter C. Everett, Kei Suzuki, Kimberley Mak, Matthew H. Kulke, Umit Tapan
Journal: Journal of Clinical Oncology (2023)

e21220 Background: The development of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitors (ICIs) has been associated with improved clinical outcomes in advanced non-small cell lung cancer (NSCLC). However, how this association extends across race and ethnicity remains uncertain. In this study, we evaluated the association between the development of irAEs and treatment outcomes across different racial and ethnic groups treated at a single institution. Methods: We performed a retrospective chart review to identify irAEs and treatment outcomes in patients with advanced NSCLC who had received treatment with ICIs at our institution between 2015-2020. The incidence of irAEs across racial subgroups was compared using logistic regression analysis. Cox regression analysis was carried out to evaluate the associations between the development of irAEs and treatment outcomes [Overall Survival (OS) and Progression Free Survival (PFS)] in these subgroups. Results: We identified a total of 138 NSCLC patients who received treatment with ICIs, of whom 50% (69) identified as non-Hispanic Black (NHB) and 50% (69) as others, including 34% (47) as non-Hispanic White. The overall incidence of irAEs in the cohort was 28%, with no significant difference between NHB and other racial groups (29% vs. 27.5%). However, females [OR 2.3 (1.1-4.8)] and patients who did not have Medicare or private insurance (i.e had Medicaid or MassHealth) were found to have a higher incidence of irAEs [OR 2.7 (1.2-5.7)]. With a median follow-up time of 363 days, the proportion of patients who were progression-free was greater in patients who had experienced irAEs than in those who did not experience irAEs [HR for time to progression 0.46 (0.23 – 0.92)]. The association between irAEs and improved PFS in NHB patients was similar to the overall population [median PFS 246 vs. 181; HR 0.87 (0.58-1.29)]. Higher ECOG status, higher Charlson Comorbidity Index and receiving ICIs as 2 nd or subsequent line therapy were independently associated with worse PFS. Conclusions: Our single-institution study demonstrated a similar incidence of irAEs in patients with NSCLC across different racial and ethnic groups. As in prior studies, patients undergoing treatment with ICIs and experiencing irAEs had significantly better outcomes. We found that the association between the development of irAEs and improved treatment outcomes was independent of race and ethnicity, supporting the importance of making unbiased treatment recommendations without regard to these factors. [Table: see text]
Post-double lung transplantation survival outcomes of bilateral lung cancer and incidence of post-transplant lung cancer.
Authors: Jeeyeon Lee, Jisang Yu, Samuel Schellenberg, Il-Young Chung, Ankit Bharat, Young Kwang Chae
Journal: Journal of Clinical Oncology (2023)

e21061 Background: To evaluate the role of double lung transplantation (DLT) for lung cancer, the survival outcomes of patients who underwent DLT for lung cancer and the incidence of lung cancer after DLT were assessed. Methods: Data from case series reported in the literature were pooled and collected from the Organ Procurement Transplantation Network (OPTN) and the International Society of Heart and Lung Transplantation (ISHLT) registries. We evaluated the recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) of patients who underwent DLT for lung cancer. Moreover, the incidence and OS of post-transplant lung cancer in patients who received transplants for the non-cancerous disease were examined. Results: Regarding patients who underwent DLT for lung cancer, in the pooled (n = 19), OPTN (n = 15), and ISHLT (n = 25) data, 5-year RFS was 52.6%, 66.7%, and 80.0%, and 5-year OS was 57.9%, 26.7%, and 36.0%, respectively. The median CSS was 48.0 (range, 6.0–144.0), 27.7 (range, 0.2–66.6), and 24.0 (range, 0.1–145.1) months. Additionally, the application of cardiopulmonary bypass was associated with lower tumor recurrence in the pooled data (p = 0.004). The incidence and 5-year OS post-transplant lung cancer in patients who underwent DLT for the non-cancerous disease were 0.8% and 47.3% in the OPTN data and 0.6% and 50.7% in the ISHLT data, respectively. Conclusions: We demonstrated that reasonable survival outcomes can be achieved with DLT in patients with bilateral lung cancer. Further studies are required to evaluate the risk of post-transplant lung cancer in patients undergoing DLT for bilateral lung cancer.
The impact of large oncology meetings (#ASCO, #AACR, #ASH) and health equity hashtags (#DEI+) on social media engagement.
Authors: Don S. Dizon, Narjust Florez, Vivek Subbiah, Lachelle Dawn Weeks, Luca Dezzani, Renu Juneja, John Smith, Wanda Edobor
Journal: Journal of Clinical Oncology (2023)

e23008 Background: Social media has revolutionized scientific communication to extend engagement beyond peer-reviewed publications and traditional media channels. Hashtags (#) promote awareness of key topics and enable tracking of social media engagement (Katz et al. JAMA Oncol. 2016;2(3):392-4). We evaluated the utilization of Diversity, Equity, and Inclusion (#DEI) hashtags around large oncology meetings to describe the trends of DEI-focused social media conversations. Methods: Using Symplur Signals healthcare analytics on Twitter data, 5 dashboards with # datasets (#ASCO 18-22, #AACR 18-22, #ASH 18-22, #ASHDEI) were analyzed over 2018–2022. Data were then refined by content word filters (most used DEI hashtags: #cancerdisparities, #healthdisparities, #healthequity). Utilizing proprietary natural language processing combined with artificial intelligence, the Netbase Quid platform used a Boolean algorithm to collect ASCO DEI social media data (Twitter and others) to identify discussion themes between January 2021 – January 2023. Results: Use of the ASCO hashtag resulted in high and relatively stable social media activity from 2018-2022 (Table). In contrast, a major decline in both the DEI and DEI+ASCO hashtags occurred in 2022 after the peak in 2021 (Table). The peak use of DEI hashtags coincided with sentinel events in the US, including the deaths of George Floyd and Breonna Taylor and subsequent public protests. However, DEI conversations made up only 2% of ASCO’s social media conversations and accounted for far less for American Society of Hematology (ASH) and American Association for Cancer Research (AACR) (Table). Although smaller in number, AACR hashtags (#AACR, +DEI hashtags) were stable in 2021-22 compared with ASCO and ASH, coinciding with a dedicated conference focus on DEI topics during the AACR meeting. Conclusions: In general, oncology-associated Twitter activity appeared to be less frequent, possibly due to inconsistent use of DEI hashtags. To generate consistent and searchable DEI social media activity—and to communicate the outcomes of DEI initiatives—the oncology community should develop a lexicon of DEI hashtags. [Table: see text]